- Medically Reviewed by: Mr Mfazo Hove, Consultant Ophthalmic Surgeon
- Author: Mr Mfazo Hove
- Published: December 6, 2024
- Last Updated: October 6, 2026
TL;DR: Everyone develops cataract, clouding of the natural lens, eventually, with or without an ICL (Implantable Collamer Lens). An ICL can bring this forward in some eyes, particularly when it sits too close to the natural lens or is implanted later in life, although modern lens designs, careful sizing and long-term monitoring have made this much less common. The honest answer is not “never”, but “uncommon, detectable early, and treatable”.
The question is not whether a cataract will ever form. It is whether it forms earlier than it would have, and whether anyone is watching.
How Implantable Collamer Lens Surgery Can Affect Your Natural Lens
Implantable Collamer Lens Surgery places an ICL just in front of your natural lens, separated by a small gap called the vault. If that gap is too small, or fluid circulation around the lens is reduced, the front surface of the natural lens can become cloudy.
This type of change, called an anterior subcapsular opacity, means clouding just beneath the front surface of the natural lens. It is the form of cataract most associated with ICLs.
Where the ICL sits: behind the iris, the coloured part of your eye, and in front of your natural lens. The gap between the two is the vault, and keeping it in range protects the natural lens.
What The Long-Term Studies Show
- Age matters. In a 10-year study of 110 eyes with earlier lens designs, patients who had surgery at 30 or younger had a lower risk of later lens opacity, meaning clouding of the lens. ¹
- Design matters. A 10-year study of earlier lens designs without a central port, a small opening that allows the eye’s natural fluid to pass through, found cataract formation in a substantial proportion of eyes. It occurred more often in older patients and those with higher myopia, meaning short-sightedness. ²
- The central port helped. Reviews of central-port ICLs, which allow fluid to flow through the lens, report low rates of cataract and other adverse events, meaning complications or unwanted effects. ³ ⁴
- Ten-year follow-up of eyes with earlier lens designs showed stable outcomes in most eyes. ⁵ Evidence for central-port lenses covers a shorter period and continues to accumulate.
How Your Eye Clinic Can Help Reduce Risk
When choosing an eye clinic, the most important factor you can influence is the choice of surgeon and the quality of sizing. A lens sized to sit within a safe vault range, away from the natural lens, reduces the risk of contact. ⁶ Our article on ICL sizing and suitability explains how this is measured.
Monitoring matters too. Under the ICL Lifetime Monitoring Protocol™, your natural lens is examined at every visit.
Any new cortical opacity, clouding in the outer layers of the natural lens, or anterior subcapsular opacity is a defined threshold for consultant review, at no additional cost.
If A Cataract Does Develop
Cataract after an ICL is treated by removing the ICL and performing cataract surgery, usually in a single operation, with a new lens implant that can also correct your prescription.
Blue Fin Vision® publishes the price of that pathway in advance:
- Within two years of implantation: no charge.
- From two to ten years: half price.
- After ten years: our standard fixed cataract price.
Our article on what happens if you get cataracts after ICL covers the operation in detail.
Further Reading
Before your consultation, explore these resources:
- Read our phakic intraocular lens information, covering lenses implanted inside the eye while leaving the natural lens in place.
- Use our ICL surgery checklist to prepare your questions.
References
- Choi JH, Lim DH, Nam SW, Yang CM, Chung ES, Chung TY. Ten-year clinical outcomes after implantation of a posterior chamber phakic intraocular lens for myopia. J Cataract Refract Surg. 2019;45(11):1555-61. doi:10.1016/j.jcrs.2019.06.015.
- Guber I, Mouvet V, Bergin C, Perritaz S, Othenin-Girard P, Majo F. Clinical outcomes and cataract formation rates in eyes 10 years after posterior phakic lens implantation for myopia. JAMA Ophthalmol. 2016;134(5):487-94.
- Packer M. The Implantable Collamer Lens with a central port: review of the literature. Clin Ophthalmol. 2018;12:2427-38. doi:10.2147/OPTH.S188785.
- Montés-Micó R, Ruiz-Mesa R, Rodríguez-Prats JL, Tañá-Rivero P. Posterior-chamber phakic implantable collamer lenses with a central port: a review. Acta Ophthalmol. 2021;99(3):e288-e301. doi:10.1111/aos.14599.
- Nakamura T, Isogai N, Kojima T, Yoshida Y, Sugiyama Y. Posterior chamber phakic intraocular lens implantation for the correction of myopia and myopic astigmatism: a retrospective 10-year follow-up study. Am J Ophthalmol. 2019;206:1-10. doi:10.1016/j.ajo.2019.04.024.
- Fernandes P, González-Méijome JM, Madrid-Costa D, Ferrer-Blasco T, Jorge J, Montés-Micó R. Implantable collamer posterior chamber intraocular lenses: a review of potential complications. J Refract Surg. 2011;27(10):765-76. doi:10.3928/1081597X-20110617-01.
ABOUT THE AUTHOR
Mr Mfazo Hove
Consultant Ophthalmic Surgeon
MBChB MD FRCOphth CertLRS
Mr Mfazo Hove is a Consultant Ophthalmic Surgeon with experience spanning more than 57,000 procedures. He completed 6.5 years of specialist training at Moorfields Eye Hospital and served for five years as a consultant at the Western Eye Hospital, Imperial College Healthcare NHS Trust. He is the founder of Blue Fin Vision®, a consultant-led private ophthalmology practice operating across London, Essex, and Hertfordshire. His clinical expertise encompasses advanced cataract surgery, refractive lens replacement, laser vision correction, and implantable Collamer lenses (ICL).
A ZEISS Key Opinion Leader, Mr Hove is a respected international speaker with five invited engagements across seven cities in 2026:
- ZEISS China tour (Changsha, Shanghai, and Hangzhou, April – ZEISS APAC User Meeting)
- RCOphth Annual Congress – May – Manchester
- ZEISS EMEA User Meeting (Istanbul)
- ZEISS Lausanne User Meeting (Lausanne)
- European Society of Cataract and Refractive Surgeons Annual Congress (ESCRS, London)
Schedule Your Consultation Today
Book a paid ICL suitability consultation with the consultant-led team at Blue Fin Vision®, with clinics in London, Hertfordshire and Essex.
Discuss your individual cataract risk, treatment options and long-term monitoring before deciding whether ICL surgery is right for you.
